Race, income and location play a role in access to stroke care, study finds

Residents of predominantly black communities are more likely than those of predominantly white communities to live near a hospital with a certified stroke center. But a new study shows that when residents of these black communities have a stroke, they are at greater risk of receiving care in a less resourced hospital, where their chances of recovery are slimmer.

In their retrospective study, researchers led by corresponding author Renee Hsia, MD, MSc, of the Department of Emergency Medicine at UC San Francisco, followed the demographics of patients in general acute care hospitals in the United States that offered stroke certification over a 10-year period. duration. Of the 4,984 hospitals, 961 were stroke-certified in 2009, up from 1,763 in 2019, the researchers reported in their study published in JAMA Neurology June 27, 2022.

Stroke center certification ranges from primary stroke centers, which provide standard care, to comprehensive stroke centers that can handle the most complex cases. Treatment in stroke centers is associated with lower rates of death and severe disability, according to recent studies that point to features such as rapid triage, specialized neurosurgeons, advanced imaging facilities and a rapid access to thrombectomy, a surgical procedure to remove a blood clot from inside an artery or vein.

The researchers found that residents of majority-black communities, which were served by 10% of the hospitals in the study, were 1.67 times more likely to live near hospitals with stroke centers, compared to to residents of majority white communities. However, after adjusting for population and hospital bed capacity, these patients were 26% less likely to receive care there, the researchers said.

Increased Demand for Stroke Care in Black Communities

Racially segregated black communities tended to cluster in high population areas, where there is a much higher level of demand for stroke care. Overcrowding can prevent patients from getting to the stroke center, and even if they get there, they may not be able to be seen as quickly due to lack of beds, critical care doctors, nurses and equipment. »


Renee Hsia, MD, MSc, UCSF Senior Faculty Member Philip R. Lee Institute for Health Policy Studies

The researchers also found a significant disparity in access to stroke centers when they compared resident resource levels. Residents of predominantly high-income areas were 3.4 times more likely to live near a hospital with a certified stroke center compared to residents of predominantly low-income areas. Similarly, patients in rural areas were significantly less likely to be served by hospitals with certified stroke centers than those in urban areas.

The decision to open a new stroke center should consider the size of the population and the underlying needs of the community the center will serve, Hsia said. “Currently, the delivery of stroke care is driven more by profit potential than by community need. they can reduce financial barriers for hospitals in those communities where certified stroke centers are needed.”

About Antoine L. Cassell

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